Operation time as a simple indicator to predict the overcoming of the learning curve in gastric cancer surgery: a multicenter cohort study

Tae Han Kim, Keun Won Ryu, Jun Ho Lee, Gyu Seok Cho, Woo Jin Hyung, Chan Young Kim, Min Chan Kim, Seung Wan Ryu, Dong Woo Shin, Hyuk Joon Lee

Research output: Contribution to journalArticle

Abstract

Background: The aim of this study is to identify an indicator to predict the overcoming of the learning curve of distal gastrectomy in gastric cancer surgery. Method: A retrospective multicenter cohort study was conducted in 2100 patients who underwent radical distal gastrectomy performed by nine surgeons in eight hospitals between 2001 and 2006. For each surgeon, an individual CUSUM chart was formulated in terms of operation time or clinical outcomes, including severe complications, number of retrieved lymph nodes, positive resection margin, and hospital stay. The actual changing points (CPs) of the CUSUM charts were analyzed. Based on the CP, patients were divided into pre-CP and post-CP groups, and the clinicopathologic outcomes and survival data were compared between the groups. Results: CP determined by operation time was more reliable than CP determined by a combination of clinical outcomes, as the former was correlated not only with short-term outcomes but also with survival. The outcomes were superior in the post-CP group in terms of numbers of harvested lymph nodes, sufficient lymph node harvesting (> 15), and negative proximal margins. In a survival analysis, the post-CP group showed better survival than the pre-CP group in stage II (76% vs 86.1% p = 0.010) and stage III (51.5% vs 60.6% p = 0.042). Conclusion: Overcoming the learning curve of distal gastrectomy for gastric cancer can be better predicted by operation time rather than by a combination of postoperative clinical parameters. It is recommended that surgeons initially operate on early stage cancer patients before overcoming the learning curve.

Original languageEnglish
Pages (from-to)1069-1080
Number of pages12
JournalGastric Cancer
Volume22
Issue number5
DOIs
Publication statusPublished - 2019 Sep 5

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research

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    Kim, T. H., Ryu, K. W., Lee, J. H., Cho, G. S., Hyung, W. J., Kim, C. Y., Kim, M. C., Ryu, S. W., Shin, D. W., & Lee, H. J. (2019). Operation time as a simple indicator to predict the overcoming of the learning curve in gastric cancer surgery: a multicenter cohort study. Gastric Cancer, 22(5), 1069-1080. https://doi.org/10.1007/s10120-019-00948-6